The objective of this study is to assess clinical and patient characteristics before and after the implementation of a controlled substance agreement at ARUP Family Medicine clinic. This study aims to determine the level of adherence to the guidelines post-implementation of a controlled substance agreement by patients seen at ARUP Primary Care Clinic and identify the characteristics of controlled substance medications before and after implementing a controlled substance agreement.
We conducted a single center, retrospective, cohort study collecting patient data over 12-month period pre-implementation and post-implementation of a controlled substance agreement (CSA) through electronic health record (EHR) chart review and abstraction. This retrospective chart review took place at ARUP Family Health Clinic, the study center. Descriptive statistics were used to describe sample characteristics. Odds ratios (ORs) were calculated with associated 95% CIs, and differences were considered significant if OR CIs did not include 1.0 and the associated P values were less than 0.05.
Of the final sample, 87% of patients were not first started on non-controlled substance medications. Table 2 reports changes in the number of refills and PCP visits between the pre-and post-implementation periods. After CSA enrollment, an increased was observed in the number of refills (OR, 0.81; 95% CI, 0.54 – 1.21), and in primary care provider visits (OR, 0.84; 95% CI, 0.56 – 1.26).
The implementation of a schedule II to V controlled substance agreement improved the number of patient agreements singed (53%), the number refills made by the prescribers to appropriately manage the medications need of their patients, and significantly decreased the number of schedules II to V prescriptions written outside a mandatory 3-month office visit by showing an increased in the number of primary care providers visit post-implementation of a controlled substance agreement.
- Compton WM, Han B, Blanco C, Johnson K, Jones CM. Prevalence and correlates of prescription stimulant use, misuse, use disorders, and motivations for misuse among adults in the U.S. Am J Psychiatry. 2018;175(8):741-755. doi:10.1176/appi.ajp.2018.17091048
- Benzodiazepines: A Major Component in Unintentional Prescription Drug Overdoses With Opioid Analgesics – Michael Jann, William Klugh Kennedy, Gaylord Lopez, 2014. https://journals.sagepub.com/doi/10.1177/0897190013515001. Accessed March 9, 2020.
- Hah, Jennifer M., John A. Sturgeon, Jennifer Zocca, Yasamin Sharifzadeh, and Sean C. Mackey. “Factors Associated with Prescription Opioid Misuse in a Cross-Sectional Cohort of Patients with Chronic Non-Cancer Pain.” Journal of Pain Research 10 (2017): 979–87. https://doi.org/10.2147/JPR.S131979.
- Philpot, Lindsey M., Priya Ramar, Muhamad Y. Elrashidi, Raphael Mwangi, Frederick North, and Jon O. Ebbert. “Controlled Substance Agreements for Opioids in a Primary Care Practice.” Journal of Pharmaceutical Policy and Practice 10, no. 1 (2017): 1–7. https://doi.org/10.1186/s40545-017-0119-5.
- Philpot, Lindsey M., Priya Ramar, Muhamad Y. Elrashidi, Tiffany A. Sinclair, and Jon O. Ebbert. “A Before and After Analysis of Health Care Utilization by Patients Enrolled in Opioid Controlled Substance Agreements for Chronic Noncancer Pain.” Mayo Clinic Proceedings 93, no. 10 (2018): 1431–39. https://doi.org/10.1016/j.mayocp.2018.05.008.
- Hedden SL, Kennet J, Lipari R, et al. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
- Report, Mortality Weekly. “Erratum to: CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 (Morbidity and Mortality Weekly Report, (2016), 65, RR-1).” Morbidity and Mortality Weekly Report 65, no. 11 (2016): 295.
- Downey, Erin, Wei Pan, Jan Harrison, Esther Poza-Juncal, and Paula Tanabe. “Implementation of a Schedule II Patient Agreement for Opioids and Stimulants in an Adult Primary Care Practice.” Journal of Family Medicine and Primary Care 6, no. 1 (2017): 52. https://doi.org/10.4103/2249-4863.214959.